Liver abscess and subhepatic abscess: a case report from a community general practitioner

The article presents a case report of an atypical liver abscess and subhepatic abscess reported by a community general practitioner.

Bacterial liver abscess is a rare condition. Earlier, liver abscesses were described as a consequence of peritonitis in children. Recently, there have been increasing reports of purulent liver abscesses in geriatric patients. No significant differences were found in the incidence of liver abscess by geographic area, race, or sex. Primary or secondary immunodeficiency plays an important role in this disease. Predisposing factors for liver abscess include malignancy, abdominal surgery or endoscopic manipulation, diabetes mellitus, colitis, diverticulitis, and trauma. Liver abscesses are classified as cholangitic, hematogenous, lymphogenous, and pylephlebitic according to the International Classification of Diseases, 10th Revision. These cases should be diagnosed by careful medical history, detailed assessment of examination data and cognitive manifestations in geriatric patients. A surgeon and a geriatrician should be consulted. Dynamic ultrasound and computed tomography should also be performed.

This case report illustrates not only the difficulty of diagnosing liver abscess in the outpatient setting, but also the need to pay special attention to geriatric patients with cognitive dysfunction, which may be misdiagnosed as a manifestation of cerebrovascular disease rather than severe intoxication.

This case will be of interest to primary care physicians such as general practitioners, gastroenterologists, surgeons, infectious disease specialists, and geriatricians.